High Blood Pressure Treatment (cont.)

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

These complications of hypertension often are referred to as end-organ damage. Because of this damage, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.

People with high blood pressure have an increased stiffness, or resistance, in the arteries throughout the tissues of the body. This increased resistance causes the heart muscle to work harder to pump the blood through the arteries. The increased workload can put a strain on the heart, which can lead to heart abnormalities that are usually first seen as an enlarged heart muscle. Heart enlargement may be a forerunner of heart failure, coronary (heart) artery disease, and abnormal heart rate or rhythms (cardiac arrhythmias). Proper treatment of the high blood pressure and its complications can reverse some of these heart abnormalities.

Blood and urine tests may be helpful in detecting kidney abnormalities in people with high blood pressure. (Kidney damage can be either the cause or the result of hypertension.) Measuring the serum creatinine in the blood can assess how well the kidneys are functioning. An elevated level of serum creatinine indicates damage to the kidneys. In addition, the presence of protein in the urine (proteinuria) may reflect chronic kidney damage from hypertension, even if kidney function (as represented by the blood creatinine level) is normal. African American patients with poorly controlled hypertension are at a higher risk than Caucasians for most end-organ damage and, particularly, kidney damage.

Uncontrolled high blood pressure (hypertension) can cause strokes, which can lead to brain or neurological damage. The strokes are usually due to a hemorrhage (leaking blood) or a blood clot (thrombosis) of the blood vessels that supply blood to the brain. The patient's symptoms and signs (findings on physical examination) are evaluated to assess the neurological damage. A stroke can cause weakness, tingling, or paralysis of the arms or legs and difficulties with speech or vision. Multiple small strokes can lead to dementia (impaired intellectual capacity). The best prevention for this complication of hypertension or, for that matter, for any of the complications, is control of the blood pressure. Recent studies have also suggested the ARBs may offer an additional protective effect against strokes above and beyond control of blood pressure.